New Concepts in Antimicrobial Treatment for Complicated Urinary Tract Infections: Single Daily Aminoglycoside Dosing and ‘Switch’ Therapy

UTI in Children

“…PO antibiotic therapy for children with UTIs has the advantages of ease and cost over IV therapy. (24)(25)(26)(27)(28)(29)(30) The lack of association between the length of intravenous antibiotic therapy and subsequent treatment failure reported in recent years. In a prospective, randomized trial the incidence of renal scars was similar in patients who received 3 days compared 8 days of intravenous www.intechopen.com UTI in Children 305 ceftriaxone.…”

“…Increased renal height at initial ultrasound examination and grade 3 VUR were significant risk factors for renal scars. (28)(29)(30) Hodson et al identified po antibiotics appear to be as effective as initial IV antibiotics for UTIs in children older than one month of age with no known structural urological abnormality. (24) Perri et al reported the oral antibiotics equivalent to intravenous antibiotics for the initial management of pyelonephritis in children .Two nuclear radiologists interpreted the renal scans independently and resolved any discrepancies by consensus.…”

“…However, these children have a higher risk of renal scarring than children without VUR. (28)(29)(30) The standard antibiotic therapy was sequential IV cefotaxime or ceftriaxone for three days, followed by cefixime , amoxi -clavulanate or ceftibutin for either seven days or 11 days versus the same total duration with po antibiotics alone. Response rate in cases with switch therapy was higher than children treated with intravenous aminoglycoside (88% vs. 80%; p value = 0.82).…”

“…If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. (25)(26)(27)(28)(29)(30) Cefixime is a third-generation oral cephalosporin that is highly active against a broad range of gram-negative and some gram-positive aerobic bacteria, and has a low rate of side effects. On the basis of the literature data, cefixime could be indicated in the treatment of UTIs in children either as monotherapy or as switch therapy.…”

“…Complications such as renal or peri renal abscess are well demonstrated by CT or US (17) Although imaging studies have been considered after the diagnosis of a first urinary tract infection, the effect of such studies on outcome has been unclear. Recently, low radiation procedures recommended for diagnosis of VUR (18) Urinary tract infections accounting for a considerable percentage of antibiotic prescriptions in some countries (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) The prevalence of resistant gram negative organisms is increased during last decade (19,20) The first febrile uncomplicated UTI in children is caused by E coli in 70% to 90% of cases. In recent studies a high rates of resistant uropathogens (other than E coli) to various antimicrobial agents in children received prophylactic antibiotics prophylaxis (21)(22)(23)(24).…”